• Pain Med · Jun 2015

    Multicenter Study Observational Study

    Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration.

    • Joseph W Frank, Evan P Carey, Katherine M Fagan, David C Aron, Jeff Todd-Stenberg, Brent A Moore, Robert D Kerns, David H Au, P Michael Ho, and Susan R Kirsh.
    • VA Eastern Colorado Health Care System, Denver, Colorado.
    • Pain Med. 2015 Jun 1;16(6):1090-100.

    ObjectiveHalf of all Veterans experience chronic pain yet many face geographical barriers to specialty pain care. In 2011, the Veterans Health Administration (VHA) launched the Specialty Care Access Network-ECHO (SCAN-ECHO), which uses telehealth technology to provide primary care providers with case-based specialist consultation and pain management education. Our objective was to evaluate the pilot SCAN-ECHO pain management program (SCAN-ECHO-PM).Design And SettingThis was a longitudinal observational evaluation of SCAN-ECHO-PM in seven regional VHA healthcare networks.MethodsWe identified the patient panels of primary care providers who submitted a consultation to one or more SCAN-ECHO-PM sessions. We constructed multivariable Cox proportional hazards models to assess the association between provider SCAN-ECHO-PM consultation and 1) delivery of outpatient care (physical medicine, mental health, substance use disorder, and pain medicine) and 2) medication initiation (antidepressants, anticonvulsants, and opioid analgesics).ResultsPrimary care providers (N = 159) who presented one or more SCAN-ECHO-PM sessions had patient panels of 22,454 patients with chronic noncancer pain (CNCP). Provider consultation to SCAN-ECHO-PM was associated with utilization of physical medicine [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.05-1.14] but not mental health (HR 0.99, 95% CI 0.93-1.05), substance use disorder (HR 0.93, 95% CI 0.84-1.03) or specialty pain clinics (HR 1.01, 95% CI 0.94-1.08). SCAN-ECHO-PM consultation was associated with initiation of an antidepressant (HR 1.09, 95% CI 1.02-1.15) or anticonvulsant medication (HR 1.13, 95% CI 1.06-1.19) but not an opioid analgesic (HR 1.05, 0.99-1.10).ConclusionsSCAN-ECHO-PM was associated with increased utilization of physical medicine services and initiation of nonopioid medications among patients with CNCP. SCAN-ECHO-PM may provide a novel means of building pain management competency among primary care providers.Wiley Periodicals, Inc.

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